Patient Guide

Introduction to Acupuncture and Traditional Chinese Medicine

There is a growing trend towards the use of alternative therapies in the treatment of chronic pain and disease. The popularity of alternative medicine has emerged as consumers have become more informed, (ie: articles in Life Magazine, a feature story on Turning Point on NRC, local newspaper articles and T.V.). People are recognizing that Western Medicine has its limitations, particularly in the treatment of chronic disorders. This may be due to their frustration with the medical system. But, the trend appears to reflect the patient’s need to have control over their healing process and access to a variety of therapies. As patients seek out alternative health care, their expectations and goals are clearly articulated and health care practitioners providing these services need to pay particular attention to whether patient is an appropriate candidate for that particular type of therapy.

Western medicine has its limitations and so does alternative therapies, particularly with regards to acute disorders. When is it appropriate for a patient to seek out complementary or alternative therapy? What is the process? How do patients access this type of service? What are the political and economic concerns? What risks are involved? These are the more frequently asked questions about Acupuncture and Traditional Chinese Medicine.

Acupuncture and Traditional Chinese Medicine Evolves as the 21st Century Medicine: The Road to Regulation Historical Background

January 1995, Joanne Pritchard-Sobhani and Darab Sobhani, established their practice in Brockville at Chelsea Court. In 1997 they established the Institute of Acupuncture & Traditional Chinese Medicine, (IATCM) which functioned as a teaching and clinical facility. It seems just like yesterday, but, the future of Acupuncture and Traditional Chinese Medicine is no longer in question or perceived as an alternative practice. The Profession has rapidly become one of the more widely used medical systems within Canada the United States, England and Australia. It is a primary care profession that is totally integrated within China and throughout Asia.

Traditional Chinese Medicine is a unique, comprehensive medical system that includes the use of: TCM Acupuncture, Herbal Medicine, Dietary Therapy and manual therapies (tuina- chinese massage,tai chi and qigong) within the scope of practice of the TCM profession. It should be clarified that the practice of Traditional Chinese Medicine is not defined by culture or ethnic background, but rather by the specific body of knowledge or theoretical framework from which TCM emerges.

Within this conceptual framework, IATCM, established a 3 and 4 -year curriculum, which at that time taught different levels of competency in anticipation for registration as an Acupuncturist and or a TCM Practitioner, once regulation occurred. In 2003, we suspended our academic program. Until regulation of the profession became a reality, teaching 3 and 4 year programs was challenging as many students opted to take short term courses as there were no standards of education or practice to guide the profession. Instead, we focused our efforts in our Clinical practice and and in lobbying the Provincial Government starting in 1996 for regulation of Traditional Chinese Medicine and Acupuncture to protect patients from harm from unqualified practitioners. Professor Cedric Cheung, President of The Chinese Medicine and Acupuncture Association of Canada, (CMAAC) initiated the regulatory process in 1994. On behalf of CMAAC he submitted a 10,000, signature petition with a request to the Provincial Government to regulate the TCM/A profession. The government responded and started the regulatory process. This turned out to be a very long political and challenging process. Joanne working both independently and as the Liaison Officer for CMAAC in writing joint submissions to government, lobbying MPP’s, attending political fund raisers for each successive government, and making submissions to Standing Committee hearings.

British Columbia regulated the whole profession of Traditional Chinese Medicine and Acupuncture, through tiered registration as Acupuncturists, Herbalists and Doctors of Traditional Chinese Medicine. Ontario, completed submissions in September 2000.

The Health Professional Advisory Council, (HPRAC) of Ontario made recommendations to the Ministry of Health in March 2001. In 2003, the Minister of Health, Tony Clement established at TCM/Advisory Board, where Joanne was appointed along with other TCM/A key stakeholders and regulated professions. It was historical in that many

participants started to work towards a common goal despite years of conflict both within the TCM profession and externally. The TCM/Advisory Board made specific recommendations to the Minister of Health, Ministry of Health and Long Term Care in response to the HPRAC report, noting specific concerns in terms of standards of education and practice, controlled acts, title protection, tiered registration and the Doctor title. In 2006, the Provincial Minister of Health, George Smitherman, was finally able to announce that Bill 50, referred to as “The Traditional Chinese Medicine Act” was passed. In 2007, the Registrar of the Transitional College of Traditional Chinese Medicine Practitioners and Acupuncturists, Ontario was hired and in June 2008, the first inaugural meeting was held with a

15-member council appointed by the Lieutenant Governor and the Minister of Health. The transitional council of the College of Traditional Chinese Medicine Practitioners and Acupuncturists of Ontario would develop the framework for the future “College” to regulate the profession by establishing regulations, standards of practice, entry-level competencies, policies and procedures, By-laws and the Pan-Canadian Examinations Joanne was appointed by the Government to the transitional Council in 2008 and after 2010, she remained on Council with 4 other appointed members until November 2013. Joanne became President of the transitional Council in 2011-2013 and played a key role in ensuring the Council successfully completed and implemented a Pre-proclamation work plan prior to regulation which was expected to be April 1, 2013. This meant The College of Traditional Chinese Medicine Practitioners and Acupuncturists Ontario would be proclaimed on April 1, 2013 and anyone practicing the profession must be registered with the College by April 1, 2013 as it would be illegal to practice as a Traditional Chinese Medicine Practitioner or Acupuncturist after that date. The task of registering what turned out to be over 3,000 practitioners was extremely challenging, but it was accomplished. Joanne was elected to Council of the newly established College, again in 2013 and re-elected as President of the College until March 1, 2016. In December 2014, as President and with Council approval, an ad hoc committee was established for the development of the Dr. TCM Title regulation. The College continues to work on the Dr. TCM Title regulation.

Traditional Chinese Medicine and Acupuncture in Ontario therefore, became regulated in 2013 under the Traditional Chinese Medicine Act, 2006 and the Regulated Health Professions Act. The profession is regulated by the College of Traditional Chinese Medicine Practitioners and Acupuncturists of Ontario which authorizes only members of the College to use the protected titles, “Traditional Chinese Medicine Practitioners and Acupuncturists and two controlled acts.” No other profession is authorized to use these titles or perform these controlled acts. Eight other regulated practitioners were granted exemptions under the TCM Act to perform acupuncture, but only within their scope of practice using Western Diagnosis. They are not authorized to “communicated a traditional Chinese Medicine diagnosis or perform acupuncture below the mucous membrane for the purpose of performing acupuncture.”

The scope of practice of a Traditional Chinese Medicine Practitioner and or Acupuncturists as defined in the Traditional Chinese Medicine Act, 2006 (s.3) states: The practice of traditional Chinese medicine is the assessment of body system disorders through traditional Chinese Medicine techniques and treatment using traditional Chinese Medicine therapies to promote, maintain and restore health.

Section 4 of the Traditional Chinese Medicine Act, 2006 authorizes only the TCM profession to use the following:

Performing a procedure on tissue below the dermis and below the surface of the mucous membrane for the purpose of performing acupuncture.

Communicating a traditional Chinese medicine diagnosis identifying a body system disorder as the cause of a person’s symptoms using traditional Chinese medicine techniques.

It is estimated that more than $3.8 billion dollars was spent in Canada in 1996/97 on Complementary Forms of therapy. Surveys by Eisenberg (1993;1998 for the United States) and Ramsay et al. (1999, for Canada), appears to be the most sophisticated study thus far of general populations and the usage of Complementary Medicine. A public opinion poll by the Angus Reid Group (1998B) found that 42% of Canadians used Complementary Medicine and practices. It also reports that 1 in 5 Canadians had started using Complementary Medicine. For those respondents reporting use of Complementary Medicine; acupuncture, herbal medicine, chiropractic care and homeopathy were some of the more common types of therapy used.

The results of the studies cited above portray a clear pattern in terms of use of these therapies and practitioners. The use of such therapies and providers are not insignificant, and their use is growing in popularity. This is a trend that is expected to continue as the demand for these therapies focus on the prevention of illness and the treatment of chronic disorders, viewed by many practitioners as bridging the gap between Western Allopathic medicine, which is more traditionally an Intervention model.

Governments over the last decade have promoted more individual responsibility for promoting health, and as

governments continue to promote broader approaches to wellness as part of health care reform, we might expect that individuals will pursue paths other than conventional medicine as a reasonable response.

As patient use increases, we have a responsibility to ensure that the public is protected and this reflects in terms of standards of education and safe practice which in now being implemented by the College of Traditional Chinese Medicine Practitioners and Acupuncturists of Ontario. It governs only Traditional Chinese Medicine Practitioners and Acupuncturists registered with the College, not other regulated health professions who perform acupuncture in their scope of practice.

Regulation of the Profession is timely, given the overall changes to Health reforms. This is what Canadians need to know and most of all what our community should know to be able to make informed choices regarding their health care needs.

There are tremendous strides forwards in this regard. Provincial and Federal Governments view the integration of Complementary Forms of Medicine as part of the solution of the crisis in health care today. Many extended health care plans do provide limited coverage. Integration into the health care system will provide relief but the extent of 3rd party coverage still needs to improve. The Canadian experience is unique and is a dynamic evolutionary process that has emerged in response to patient demand which cannot be compared to Complementary Medicine in the U.S.A. It thrives because health care costs are incurred directly /indirectly by the patients in which their decisions regarding health care is one of choice.

Bridging the gap and improving communication between Allopathic Medicine is necessary if the delivery of services to the patient are to be more effective. Patients shouldn’t be afraid to discuss with their family doctor whether they are seeking treatment from Complementary Health Care Practitioners, but the Eisenberg report stated that many patients don’t communicate this with their family doctor for fear of disapproval or withdrawal of services. Up until recently, many doctors have been resistant to patients seeking alternative therapies, but now the College of Physicians and Surgeons has established a division of Complementary Medicine, specific for Physicians. Joanne has lectured at Queens University on Acupuncture and Traditional Chinese Medicine for the Department of Medicine to first and second year students studying complementary medicine as part of their program. She also critiqued a paper: “A review of Qigong Therapy” which was subject to Queens University peer review for publication in the Journal of Medicine.

The profession of Traditional Chinese Medicine and Acupuncture is at a critical turning point. Advancements in the field are phenomenal where evidence-based research continues to develop around the world.

As we envision the future of our practice, our major focus is to provide services to our patients that effectively and safely responds to their health care needs. Although, acupuncture is noted for its effectiveness in treating pain, our scope of practice is much broader and includes the treatment of chronic diseases and prevention of disease.In 2003, we committed to a major expansion to our clinical practice to include an on-site “Traditional Chinese Medicine Herbal Apothecary” which now incorporates the use of Traditional Chinese Medicine, Concentrated Extracts in the form of granules or powder. Although, we have always used raw herbs, botanicals and patented herbs in our practice; the demand for concentrated extracts has increased. WE use one of the largest Traditional Chinese Medicine Pharmaceutical Company that is the leader in TCM herbal extracts in both Taiwan and the United States. Our choice of concentrated extracts is based on the fact they are standardized, safe and effective. These companies are well known for their reputation for strict quality control that starts from herb origin. Our goals reflect the utilization of the most advanced scientific processes to bring Safe, Consistent and Effective Chinese Herbal Extracts for the health and well- being of our patients. Some, patented products brought into Canada have been banned pending, further investigation, which is the main reason that we have developed our own Herbal Apothecary. Chinese Medicine has made its way into a number of products available over the counter in pharmacies and health food stores as well.

These are quite different. We prepare our own herbal prescriptions based on TCM differential diagnosis, according to the individual’s condition.

The use of Concentrated extracts is available to “TCM practitioners” which are regulated by Health Canada’s Division of Natural Health Products. This eliminates concerns, regarding the appropriate use of these herbs, contamination and the use of endangered species. It should be noted that none of our products are available for sale for retail purposes. Our clinic dispenses herbs, only in the context of the treatment process. They are available to patients by prescription which ensures that the patient is appropriately supervised. Concentrated extracts also offer flexibility for patients in the form of decoctions or capsules vs. the tedious task of having to boil down raw herbs on a daily basis.

How does TCM/Acupuncture differ from Adjunct or Anatomical Acupuncture?

The problem inherent in Canada prior to regulation was the lack of educational institutions to provide appropriate education in comparison to the United States, China, Asia, Europe and Sri Lanka. Consequently, many practitioners studied extensively abroad to gain valuable clinical experience they needed. Many Internationally trained practitioners of Chinese Medicine are recognized as specialists in their field and have completed Doctorate programs. B.C. now has a class of registrants authorized to use the Doctor TCM Title and most schools teach to this level of competency. There are many private schools in Ontario that now teach either a 3 or 4-year program in Traditional Chinese Medicine and Acupuncture. Recently, two publicly funded programs in Ontario for Acupuncture and Traditional Chinese Medicine were approved by Humber and Georgian Colleges. Joanne was appointed to sit on the Traditional Chinese Medicine Program Advisory Board for Humber in February 2016.

Regulation is changing the landscape of TCM and Acupuncture in Ontario that will impact the future of health care in Ontario forever. Practitioners and or Doctors of Traditional Chinese Medicine may study anywhere between 2,700 hours to 4,000 hours. Currently, some physio- therapists, massage therapists, chiropractors and naturopaths perform acupuncture, using it as an adjunct to their practices which may be referred to as “anatomical, medical or neural acupuncture”. Adjunctive acupuncture, used as a Western modality by other health regulated professionals, is quite different as Western diagnosis guides treatment compared to TCM practitioners and Acupuncturist who use TCM Diagnosis to guide treatment. The training they receive ranges from 222 hours to 300 hours. Some have registered with the College of Traditional Chinese Medicine Practitioners and Acupuncturists as dual registrants and therefore, upon successful completion of the Prior Learning Assessment and Recognition process, they will be able to use the protected titles and communicate a TCM diagnosis. It should be noted that since regulation is complete there is a clearer understanding of each other’s scope of practice, better professional inter-collaboration and consequently, patients benefit by having the option to make an informed choice as to what type of treatment is most appropriate to treat their condition.

Contemporary Chinese Medicine incorporates ancient Chinese medical theories of Acupuncture, herbal therapy, dietary therapy and physical therapy that includes tuina and Qi Gong exercise/meditation. Traditional Chinese Medicine, (TCM), emphasizes that illness is an imbalance in the body. Treating illness is a matter of harmonizing the Qi (pronounced Chee) and restoring the natural balance in the body. TCM believes in the innate ability of the human body to heal itself by inviting the body back to health, rather than to forcefully impose change. The process involves developing awareness and responding to the body’s ability to adapt to change, physically, emotionally and spiritually. TCM is not an exclusive or ideal medical system. TCM’s strength lies in its ability to respond to chronic illness but is limited in the treatment of acute illnesses, some exceptions exist. It is at this time that a comprehensively trained TCM practitioner will refer to an appropriate medical practitioner This is a critical point. Seriously ill patients should be wary of any practitioner who claims to be able to cure cancer, etc. The integration of TCM into the Ontario health care system offers the best of both worlds by drawing upon the advances of Western medical technology and the holistic perspectives of TCM.

We are obligated to ensure that the patient is aware of the entire process involved in receiving Acupuncture/TCM in order to grasp the complexity of Chinese Medicine or the fundamental principles governing TCM diagnosis and the appropriate needling techniques. Acupuncture is not merely the insertion of a needle into an ash shi point or the point of pain.

How does a patient access these services?

Access is a critical issue, as many patients are not informed about alternative therapies. Criticism exists from both sides. Western Medicine in recognizing the value of Acupuncture/TCM have established a Complementary Medicine Committee that acknowledges integration of alternative forms of medicine into their scope of practice. The questions are no longer, “Does acupuncture work or how is to be integrated in the Western world?” There is still antagonism from both sides, particularly since only those with insurance coverage or those who can afford it are able to access Acupuncture and TCM services. It should be noted, that some people may prefer adjunctive acupuncture as a Western modality, simply because they feel more comfortable with that individual. TCM is not for everyone as the language of TCM is initially quite foreign, emerging as a very different paradigm in terms of the conceptual understanding of health/wellness.

The main issue confronting patients is one of access, particularly where one system is valued and given credibility by providing subsidization through OHIP. To the uninformed patient, one is lead to believe that if an alternative therapy is not paid for by OHIP, then it should be viewed with suspicion. This is only part of the problem in Canada as we have an expectation for free medical services. The reason why alternative and complementary care has flourished in the United States is because the political and economic environment is quite different. The concept of paying for medical services by patients is not new in the U.S.A., but rare in Canada. This discourages the use of alternative therapies that require direct payment in our monopolistic environment. In such an environment, the freedom to choose the type of medical service is denied. Only the elite and well educated individual has access to both forms of medicine. Ultimately, they have a choice to interface the two and benefit from the strengths of the other. Even when acupuncture is effective, many patients are unable to bear the cost of continuing treatment. Even though the cost is substantially lower in the long term to the patient. Both Western practitioners and T.C.M. practitioners are aware of the effects of iatrogenic drug induced diseases, perpetuated by the over use of prescriptions particularly antibiotics and opioids. One just has to examine the mortality rates in Canada, death due to complications and overdose, particularly in the elderly. It is on this basis alone that the efficacy of acupuncture should be judged. Canada however, is just in the embryonic stages of recognizing the power of acupuncture and Chinese medicine and the regulation of it will facilitate this process.

Acupuncture & TCM treatment protocols: What can I expect?

The ability to communicate in a language that is comfortable to the patient is the key. This involves the ability to be able to translate the Chinese theories simply and if necessary interface this with Western terminology. If the practitioner is unable to communicate in a language that is understandable, then patients should consider requesting the presence of a translator. Communicating a TCM diagnosis is absolutely essential in the treatment process where established treatment protocols will be clear and the patient will be aware of anticipated outcomes and the approximate length of their treatment.

No patient should continue with acupuncture for extensive periods of time without review of their progress and evaluation of the efficacy of their treatment. There are treatment protocols that must be individualized to the patient’s need.

The Power of Chinese Medicine is about balance, harmony and order!

If you expand your concept of healing to include the Chinese way of thinking, you may experience a subtle but powerful change in how you take care of yourself. Chinese medicine theory describes illness differently. You don’t catch a cold, rather you develop a disharmony. Diagnosis of disease is distinguished by the differentiation of syndromes that emerge quite differently in the human context which require different treatment modalities.

Chinese medicine envisions healing by using natural methods. You don’t kill a bug with a drug or suppress symptoms; rather you use acupuncture and herbs to dispel disharmony. Chinese medicine offers a new approach to treating physical and emotional problems by treating the mind/body/spirit as a whole in relation to the external environment.

Selecting a Practitioner and the Referral Process

When you are searching for an Acupuncturist or Traditional Chinese Medicine Practitioner investigate their area of expertise, training and whether or not the therapies they offer meet your goals. In order for you to gain the full benefit of Chinese Medicine, registered TCM practitioners and Acupuncturists should have reputable training and knowledge of the theoretical basis of Chinese medicine. If in doubt you can check the official register of CTCMPAO which confirms the area of training by title designation and whether they are a member in good standing.

Ask the questions about his or her training, length of practice, where did they study, what is their scope of practice, and of course what are their attitudes towards wellness? Do not assume that unlicensed Western Trained Doctors from China or elsewhere are qualified as an acupuncturist or TCM practitioner, or a TCM doctor, unless he/she is a registered member of CTCMPAO in good standing. Too often the assumption is made because of their Chinese heritage that they have a natural inherent ability. And it should not be assumed that other regulated practitioners are

qualified as an Acupuncturist or TCM practitioner either, unless they have registered with CTCMPAO in good standing.

The TCM profession is a primary care profession where TCM practitioners address a variety of patient complaints from simple to complex health problems. This requires competency as a practitioner to communicate a TCM diagnosis. Risk of harm exists in missed, incorrect or incomplete diagnoses and it follows that through this process that the selection of an inappropriate or harmful treatment affects the treatment outcomes by delaying appropriate intervention or by exacerbating the condition. The greatest risk of harm is a missed diagnosis that delays treatment of a condition that otherwise would have been treatable. Although, the TCM profession attempts to prevent these errors in the same ways as other primary care physicians, the prevalence of these types of errors exists within all professions where diagnostic skills are required.

Patients need to be able to make informed choices for treatment!

As a patient, you should have an understanding of the basics of Chinese medicine and what to expect if you go for acupuncture or herbal therapy. Many clinics have brochures available to assist you in determining whether you want to make an appointment. Discussing this with your family doctor is an important part of the process. This encourages integration of services in which practitioners may refer on your behalf or you may access the services directly. If the doctor is resistant in supporting a referral, understand that some doctors feel uncomfortable embracing alternative practices that they may not be knowledgeable about. The advantage of a doctor based referral is that we acquire important information that is integrated into our TCM diagnostic criteria to determine the most appropriate treatment. The other advantage is that many insurance companies provide coverage when a physician makes the recommendation for acupuncture treatment. This is an important consideration since OHIP does not cover acupuncture whether it’s performed by an M.D, regulated health practitioners, acupuncturists, or TCM practitioners. Currently, if any practitioner performs acupuncture within their scope of practice, regardless of who performs it, it is not covered under OHIP.

What do we mean that TCM offers a Holistic approach to treatment?

As a patient, you must be aware that no particular Chinese Medicine therapy, such as acupuncture or herbal remedies can deliver its full healing potential, if is separated from its theoretical framework for which the body is treated as a whole. This is what is meant when reference is made that TCM is a holistic approach. In the Western scientific model, life is dissected and separated into separate, discrete parts, within the context of a fixed, stable environment that must be measured objectively. Philosophically, this is what separates the West from the East as two opposing forces that have antagonistically aroused skepticism for many who embrace the world in such away. Embracing Chinese medicine involves a process of viewing life as a dynamic, constantly shifting relationship of one functional system within another. No aspect of the body functions as an independent, discrete entity. In other words, our emotions shape our body and our body generates feelings.

Health Preservation and Maintenance in Chinese Medicine

Acupuncture and Chinese medicine is not well understood in the West. In China, Asia, United States, Europe and Sri Lanka it is considered a comprehensive form of medical care that is integrated with Western medicine, in the treatment of illness. Tremendous emphasis is given to the prevention of illness by maintaining healthy lifestyles. Although much discussion exists about this in the West, many, of our attitudes and beliefs prevent us from making the necessary adjustment to truly embrace Chinese medicine’s true potential for healing. In a world daunted by the use of prescription drugs and expectations for immediate cures, it often comes as a great surprise that many chronic illnesses are unresponsive to pharmaceuticals. How did such a perception emerge? Consciously, or unconsciously many patients attempting to pursue healthier lifestyles never realized the potential of the human body to heal itself. This is a process however, one where the individual must challenge strong socialization processes, institutional barriers and advertisements that imply instant relief to symptoms. According to the theories of Chinese Medicine, health preservation means preserving the body condition to maintain good health, prevent disease and prolong life. The key concept of health preservation in Chinese medicine is to prevent disease before it occurs. Some basic principles and method of health preservations includes the following:

Adapt to nature: One needs to adapt to various geographical environments. In warm and humid climates, drinking herbal tea that is cooling in nature can clear heat and eliminate dampness.

We need to adapt to seasonal changes and protect ourselves from getting cold in the winter and prevent heat stroke in the summer.

Exercise regularly: Suitable and regular exercise is necessary to maintain health and wellness because it can strengthen the body constitution, increase vitality and improve physical and mental health.

Maintain a healthy diet:

Food needs to be properly prepared and cleaned whether it is cooked or eaten raw. Eating a balanced diet is essential to maintaining proper nutrition and health. Avoid highly refined, processed foods and sugar because they are high in ‘bad’ fat and cause digestive disorders by altering our metabolism and are nutritionally deficient.

Precautions and avoidance of certain foods are encouraged, depending on the individuals’ state of health. Heavy process foods for instance should be avoided when you are sick with the flu. Eating regular meals, proportional to your body’s requirement is encouraged.

Maintain a healthy mental state:

One should avoid extremes of emotional stress and learn to maintain a balance state of mind. Some helpful practices include listening to light music, practicing meditation, visualization, relaxation exercises using audio tapes or CDS and learning tai chi or qi gong.

Strengthening the body resistance to disease:

Food used as tonic to preserve health can be as simple as eating green bean soup in the summer to prevent heat stroke or drinking ginger tea in the winter to prevent the invasion of cold. Tonics are often used for older persons or individuals recovering from a serious illness to strengthen the body or prevent diseas

Tuina Massage:

Incorporate into your daily routine the use of massage or acupressure. Many school children in China alleviate the tiredness of eyes and protect eyesight by massaging the acupoints around the eyes. Massaging certain points on the head, back of the neck and around the temples can provide relief from stress and prevent tension headaches.

Prevent Infectious Disease:

Chinese Medicine is used to prevent infectious diseases in which many herbal decoctions are available. Of, course the best option is to avoid the source of infection and maintain strict hygiene habits such as washing our hands and covering our mouth if we cough.

How should a TCM practice function?

As you seek out your practitioner observe the environment in which they work. Does it meet health and safety regulations? Is it conducive to healing? Is it an appropriate clinic setting that ensures patient confidentiality and protects personal information? Does the practitioner maintain proper patient records that reflect the dates and type of treatment given? These records are essential in documenting patient’s assessments, treatment plan and monitoring progress. If no file exists or if there is no established protocol for record keeping, be wary. Fee schedules should be made available prior to treatment. Such practices are questionable and often serve as a way to avoid reporting income. The College of Traditional Chinese Medicine Practitioners and Acupuncturists of Ontario requires that every TCM practitioner or Acupuncturist maintain accurate, up to date records in English. In the event of an emergency, important information may be required regarding treatment and the use of herbal prescriptions that are legible to first responders. If there is no record of treatment, no receipts and something happens, patients have little recourse after the fact. Risk factors are very limited when acupuncture is performed by a qualified practitioner using disposable needles. As much as disposable needles are extremely costly, the cost factor far out ways the risk of infection or transmission of disease. If you question why one practitioner’s fees are higher; this is one important factor to consider as this cost is incorporated into the fee structure. Acupuncture treatment fees range from $40.00 to $120.00 per half hour depending on where you live. Our clinic fees for Acupuncture are standardized at $67.00 per hour and is GST exempt as it is considered a medical treatment.

No needle should be inserted routinely without first examining the current status of the patient and his present level of functioning. Interaction effects of combining acupuncture while using prescription medication must be monitored.

The goal of a TCM practitioner is to potentiate the effects of acupuncture, whether herbal therapy, massage, diet therapy, exercise/meditation, lifestyle changes, counselling and/or prescription medication are used to promote health and wellness.

HEALTH = Acupuncture + Dietary Changes +

Herbs + Tuina Massage.

Using TCM Therapies often results in many patients being able to reduce their medications and in some cases they are able to eliminate them, but only with the approval of their physician. Chinese Medicine is not merely inserting needles into specific acupuncture points as technicians working in an assembly line. In China, hundreds of patients may be treated, even in groups, but the course of their treatment and the duration of the treatment determines the outcome, depending on the disharmony being treated. Holistic medicine addresses the individual at all levels. It is difficult to obtain an accurate baseline in 5 minutes. Our approach recognizes the complexity of the disharmony and as such maximizes the treatment process with the patient, unless the situation is simple, but this is rarely the case.

Our clinic is proud of its achievements, striving for excellence, particularly in the prevention of disease, working with the patient towards developing healthy lifestyles and ultimately optimum health. Duration and frequency vary. Some need only a few sessions, while serious cases may require weeks or months. It is important to know that usually within 6-12 treatments there will be a positive response; either recovery from the main complaint or a decrease in the intensity and frequency of the pain. However, it is a situation that requires constant evaluation based on objective criteria, and treatment protocols. The type of needle used is important, particularly for highly sensitive patients. No patient should have to experience undue pain with the insertion of a needle. What they should experience however is the “De Qi” sensation, which is often felt as numbness, tingling, warmth, soreness, pressure, a sense of heaviness of aching sensations, and sometimes an electric like shock is felt. This is desirable and means that Qi is present and being summoned. Sometimes sensations occur around the acupuncture point as well as traveling to other areas of the body quite distant from the point of insertion. The actual experience is an individual one, with many patients quite surprised to find it relaxing and comfortable.

The Patients’ Goals

As a patient, you need to first examine whether you are looking for a TCM practitioner or Acupuncturist to treat a condition or prevention of a disease. This is a difficult concept to imagine in the West because we have been taught that only Western medicine is capable of responding to our health care needs. This is true to a point, particularly if you require intervention such as emergency treatment. If you are looking for a TCM practitioner, ensure that the individual is knowledgeable about all aspects of Chinese medicine and Western medical procedures. The individual should recognize when to make a referral to the appropriate practitioner when it is beyond their scope of practice. They should be prepared to work with all other practitioners that is in the best interest of the patient. Others prefer to have Chinese practitioners work with the primary care physician.

The decision to seek out alternative therapies is entirely dependent on the individual being informed as to his choices and recognizing his needs and goals.

Chinese medicine is a both a chronic and preventive form of medicine that attempts to intervene at all levels to change the course of a disease pattern and improve the quality of life for those who suffer from a variety of chronic disorders. In the West, our focus is on disease and suppression of symptoms and repression of our emotions.

Unfortunately, you cannot separate these two aspects as repression of emotions may lead to physical manifestations and disharmony and/or physical manifestations may lead to imbalances emotionally and spiritually.

Chinese medicine, for 5000 years has insightfully recognized that treatment must focus on the whole person. This is a time-consuming process, particularly in the West as cultural barriers and belief systems may initially prevent patients from being able to grasp the innate ability of the body to heal itself and that the individual can exercise control over their own healing process. In fact, many well informed licensed practitioners have been on the cutting edge of facilitating research to explain the effects of acupuncture/herbal therapies on the human condition. The process of embracing Chinese medicine really is a lifelong commitment to viewing health as not merely the absence of symptoms and not giving up control of your health to someone else. We encourage our patients to be active participants in the treatment process. We cannot blame the present medical system for failing to cure us. A surgeon performs open heart surgery to correct blocked arteries but we continue to smoke and eat foods that are known to have contributed to the original problem.

The Treatment Process: What does it involve?

Once you make the decision to have treatment from a Traditional Chinese practitioner you must understand that this is just the beginning….a journey in some ways towards accepting responsibility for your own health. It’s important to inquire about the types of treatment available, the risks it any, the pros and cons of the treatment modality and what kind of commitment is involved. Remember, you are not a passive recipient; becoming more aware of your

body, it’s response to external stimuli in the environment, physiologically, psychologically and spiritually, are key aspects involved in the healing process.

There are basically four main treatment modalities that a TCM practitioner may recommend but variations within these modalities exist.

These include acupuncture which may be a combination of body acupuncture, auricular acupuncture, electro-acupuncture, laser acupuncture, intra-muscular stimulation, scalp acupuncture and moxibustion.

The use of advanced technology to stimulate acupuncture points with a specific type of micro-electric stimulation may be used. Micro-current is often referred to as non- needling acupuncture which is different than

electro-acupuncture, where needles are first inserted and then an electric current is passed through the needle.

Micro-current is used to heal muscle and nerve impairments, spinal cord injury, stroke, palsy, and aids in the recuperation from surgery or sports injuries by reducing the swelling and the inflammation. This type of treatment is also capable of increasing the integrity of the muscle and the skin and is particularly helpful in facial toning. TCM practitioners refer to this as non- surgical facelifts.

Our clinic incorporates all these modalities as well as integrating where possible counselling, particularly in regards to lifestyle changes, management of stress, depression and anxiety related disorders. Relaxation techniques, guided imagery and visualization may be used. Addictions require direct and indirect therapies that interrupt specific behavioural patterns, (Cognitive Behavioural Therapy or EMDR) that may be have been entrenched over a life time. In many respects our clinic uses an eclectic approach to responding to the patient’s needs. Counselling is often a critical component in the healing process, but it doesn’t emerge in the same form that we are accustomed to in the West.

In performing acupuncture in an atmosphere that is conducive to healing... trust and safety are essential components of the healing process. Chinese massage, (tuina) often facilitates the release of tension and emotions. In the process, many patient’s comments reflect that they suddenly feel a release emotionally; some may experience a sense of euphoria. Others depending on what part of the body or what channel your working with may elicit feelings of grief, tears or sadness. Chinese medicine according to Five Element Theory explains this phenomenon. For instance, if your treating a painful condition working on the Yangming channel of the h and, grief may be elicited as it is a coupled organ of the Taiyin channel of the Hand. (Lung Channel Metal elicits the emotion grief). From a Western perspective, the Theory of Muscle Memory Retention, refers to the fact that muscle has memory and in doing any kind of body work, trauma experienced and held within certain muscle groups may elicit a strong emotional reaction with a subsequent reduction in pain. In fact, it has been hypothesized that acupuncture may interfere with the muscles memory of pain or trauma and consequently interferes with the pain mechanisms involved in the continued transmission of that pain.

We offer workshops on a variety of topics that patients have indicated would be helpful to them; particularly in the area of increasing their understanding of TCM, lifestyle changes, coping with stress, use of food as medicine, herbs, and treatment strategies for coping with particular disease patterns.

Anyone wanting any further information regarding treatment, the types of therapies we offer, or the upcoming workshops may contact us.